Insulin resistance is associated with coronary plaque vulnerability: insight from optical coherence tomography analysis

Aims Previous studies have reported that insulin resistance plays an important role in the progression of atherosclerosis. However, the relationship between insulin resistance and coronary plaque instability is not well established. The purpose of this study was to assess the relationship between insulin resistance and coronary plaque characteristics identified by optical coherence tomography (OCT). Methods and results This study enrolled 155 consecutive patients undergoing percutaneous coronary intervention. OCT image acquisitions were performed in the culprit lesions. Insulin resistance was identified using the homeostasis model assessment of insulin resistance (HOMA-IR). Subjects were divided into three tertiles according to the HOMA-IR values. Patients in the higher HOMA tertile had more frequent prevalence of lipid-rich plaques than those in the middle and lower tertiles (83 vs. 62 vs. 57%; P = 0.01). The thin-cap fibroatheroma (TCFA) prevalence rates among the higher (>2.5), middle (1.4–2.5), and lower HOMA-IR ( 2.50 (OR: 3.57; 95% CI: 1.42−9.55; P = 0.007) were independent predictors for the presence of TCFA. Conclusion This study suggests that insulin resistance might be associated with coronary plaque vulnerability.